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Howell DR, Brilliant AN, Oldham JR, Berkstresser B, Wang F, Meehan WP. Exercise in the first week following concussion among collegiate athletes: Preliminary findings. J Sci Med Sport 2019; 23:112-117. [PMID: 31522997 DOI: 10.1016/j.jsams.2019.08.294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/30/2019] [Accepted: 08/31/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Our purpose was to examine the association between exercise after concussion with symptom severity, postural control, and time to symptom-resolution. DESIGN Longitudinal cohort. METHODS Collegiate athletes (n = 72; age = 20.2 ± 1.3 years; 46% female) with concussion completed a symptom questionnaire at initial (0.6 ± 0.8 days post-injury) and follow-up (2.9 ± 1.4 days post-injury) evaluations, and a postural control assessment at follow-up. Participants were grouped into those who exercised in between the time of injury and the follow-up evaluation and those who did not. Decisions regarding post-concussion exercise were made by a sports medicine team consisting of a single team physician and athletic trainers. RESULTS Thirteen athletes were not included in the current study, resulting in an 85% response rate. Thirteen of the athletes who completed the study exercised between evaluations (18%). There was no symptom resolution time difference between groups (median = 13 [IQR = 7-18] days vs. 13 [7-23] days; p = 0.83). Symptom ratings were similar between groups at the acute post-injury assessment (median PCSS = 18.5 [7.5-26] vs. 17 [14-40]; p = 0.21), but a main effect of group after adjusting for time from injury to assessment indicated the exercise group reported lower symptom severity than the no exercise group across both assessments (p = 0.044). The dual-task gait speed of the exercise group was higher than the no exercise group (0.90 ± 0.15 vs. 0.78 ± 0.16 m/s; p = 0.02). CONCLUSIONS Athletes who were recommended aerobic exercise after concussion did not have worse outcomes than those who were not. Exercise within the first week after concussion does not appear to be associated with detrimental clinical outcomes.
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Affiliation(s)
- David R Howell
- Sports Medicine Center, Children's Hospital Colorado, USA; Department of Orthopedics, University of Colorado School of Medicine, USA; The Micheli Center for Sports Injury Prevention, USA.
| | - Anna N Brilliant
- The Micheli Center for Sports Injury Prevention, USA; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, USA
| | - Jessie R Oldham
- The Micheli Center for Sports Injury Prevention, USA; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, USA
| | | | | | - William P Meehan
- The Micheli Center for Sports Injury Prevention, USA; Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, USA; Departments of Pediatrics and Orthopaedics, Harvard Medical School, USA
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Terrin A, Mainardi F, Zanchin G, Maggioni F. Sports, physical activity and headache in the classical age: historical descriptions from the first sports textbook, "De arte gymnastica", by Girolamo Mercuriale. Neurol Sci 2018; 40:1507-1517. [PMID: 30483994 DOI: 10.1007/s10072-018-3657-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/20/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The relationship between physical activity, sports and headache presents a growing interest, testified by numerous papers recently published. The correlation between headache and sporting activities or physical exercise dates back to the classical age. We aim at promoting the development of more studies focused on the relationship between headache and physical activity. METHODS We analysed the book "De arte gymnastica", written by Girolamo Mercuriale (Forlì, Italy, 1530-1606), and considered the first "sports medical textbook". We discuss these classical literature findings in the light of the International Classification of Headache Disorders, 3rd edition. RESULTS The Author's work derives from the systematic revision of Greek, Roman and Arabic literatures about the matter. Despite some references to inveterate headaches or cold-related pains, Mercuriale does not gather specific clinical characterisations of different types of headache. However, interestingly, he reports detailed descriptions of how the same sport, or the same physical activity, could cause or give relief from head pain, depending on the precise way of practising. Mercuriale summarises 18 sports or physical activities that can give relief from headache; conversely, running or heavy activities, such as boxing, appear among the 12 contraindicated sports for people suffering from headache. CONCLUSIONS "De arte gymnastica", by Girolamo Mercuriale, is the first textbook on sports medicine. Headache if often cited along the treatise: different sports and physical activities, or various ways of practising the same action could produce opposite effects for people suffering from headache.
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Affiliation(s)
- Alberto Terrin
- Headache Centre. Department of Neuroscience, University of Padova, Padua, Italy. .,Department of Neurosciences, Neurological Clinic, University of Padova, Via Giustiniani 5, 35128, Padua, Italy.
| | | | - Giorgio Zanchin
- Headache Centre. Department of Neuroscience, University of Padova, Padua, Italy
| | - Ferdinando Maggioni
- Headache Centre. Department of Neuroscience, University of Padova, Padua, Italy
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Chowdhury AW, Saleh MAD, Hasan P, Amin MG, Khan TA, Sabah KMN, Kabir SR. Cardiac cephalgia: A headache of the heart. J Cardiol Cases 2015; 11:139-141. [PMID: 30546551 DOI: 10.1016/j.jccase.2015.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 12/24/2022] Open
Abstract
Atypical presentations of common diseases are often difficult to identify in time, nonetheless necessary, especially in cases of diseases like ischemic heart disease (IHD) which otherwise may progress into irreversible stage and ultimately, fatality, in the absence of timely administered medical treatment. We report a case of a 51-year-old male, presenting initially with only headache as the sole symptom, who later was diagnosed with severe coronary artery disease, and the symptoms resolved completely after coronary angioplasty with stenting. <Learning objective: Atypical presentations, such as headache, can be more prevalent in ischemic heart disease (IHD) than was thought of, so awareness of the possibility of IHD while assessing headache and further study to see actually how commonly headache is associated with IHD are necessary.>.
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Affiliation(s)
| | | | - Pratyay Hasan
- Lakshmipasha Union Health and Family Welfare Centre, Golapganj, Sylhet, Bangladesh
| | | | | | - K M Nurus Sabah
- Department of Cardiology, Dhaka Medical College, Dhaka, Bangladesh
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Balasundaram AP, Sullivan JS, Schneiders AG, Athens J. Symptom response following acute bouts of exercise in concussed and non-concussed individuals – A systematic narrative review. Phys Ther Sport 2013; 14:253-8. [DOI: 10.1016/j.ptsp.2013.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/10/2013] [Accepted: 06/07/2013] [Indexed: 11/25/2022]
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Murai Y, Kobayashi S, Teramoto A. Subarachnoid hemorrhage of unknown etiology along the cortical convexity. J NIPPON MED SCH 2012; 79:301-6. [PMID: 22976612 DOI: 10.1272/jnms.79.301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Only 8% to 22% of cases of subarachnoid hemorrhage (SAH) are of nonaneurysmal origin. Among these, perimesencephalic nonaneurysmal SAH is a distinct clinical and radiologic entity with normal angiographic findings and a good prognosis. In contrast, SAH of nonaneurysmal origin occurring along the cortical convexity is rare and poorly understood. We report 2 cases of subarachnoid hemorrhage along the cortical convexity and discuss their possible etiologies. METHODS In a retrospective analysis of 234 patients with SAH, we identified 2 patients with a typical computed tomographic pattern of convexity SAH that was associated with no known etiology. RESULTS In these 2 cases, the source of hemorrhage could not be identified with computed tomography, magnetic resonance imaging, or digital subtraction angiography, although neurovascular outcomes were good. The patients reported such incidents as coughing or exertion immediately before headache developed. These incidents may have caused increased intracranial pressure. CONCLUSION We suggest the possible involvement of a brief increase in intracranial pressure, such as that accompanying coughing or exertion, in the occurrence of SAH along the cortical convexity.
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Affiliation(s)
- Yasuo Murai
- Department of Neurosurgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
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Allena M, Rossi P, Tassorelli C, Ferrante E, Lisotto C, Nappi G. Focus on therapy of the Chapter IV headaches provoked by exertional factors: primary cough headache, primary exertional headache and primary headache associated with sexual activity. J Headache Pain 2010; 11:525-30. [PMID: 20890719 PMCID: PMC3476224 DOI: 10.1007/s10194-010-0261-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 09/15/2010] [Indexed: 11/27/2022] Open
Abstract
Primary cough headache, primary exertional headache and primary headache associated with sexual activity are distinct entities, even though they share several features: acute onset, the absence of structural brain disease and exertional factors as precipitating events. In this short review, we illustrate the possible treatment strategies on the basis of information collected from a systematic analysis of the international literature.
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Affiliation(s)
- Marta Allena
- Headache Science Centre, IRCCS C. Mondino National Neurological Institute Foundation, Pavia, Italy
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Bini A, Evangelista A, Castellini P, Lambru G, Ferrante T, Manzoni GC, Torelli P. Cardiac cephalgia. J Headache Pain 2009; 10:3-9. [PMID: 19139804 PMCID: PMC3451760 DOI: 10.1007/s10194-008-0087-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 11/28/2008] [Indexed: 12/22/2022] Open
Abstract
The purpose of this review was to provide a critical evaluation of medical literature on so-called “cardiac cephalgia” or “cardiac cephalalgia”. The 2004 International Classification of Headache Disorders codes cardiac cephalgia to 10.6 in the group of secondary headaches attributed to disorder of homoeostasis. This headache is hardly recognizable and is associated to an ischaemic cardiovascular event, of which it may be the only manifestation in 27% of cases. It usually occurs after exertion. Sometimes routine examinations, cardiac enzymes, ECG and even exercise stress test prove negative. In such cases, only a coronary angiogram can provide sufficient evidence for diagnosis. Cardiac cephalgia manifests itself without a specific pattern of clinical features: indeed, in this headache subtype there is a high variability of clinical manifestations between different patients and also within the same patient. It “mimics” sometimes a form of migraine either accompanied or not by autonomic symptoms, sometimes a form of tension-type headache; on other occasions, it exhibits characteristics that can hardly be interpreted as typical of primary headache. Pain location is highly variable. When the headache occurs as the only manifestation of an acute coronary event, the clues for suspicion are a) older age at onset, b) no past medical history of headache, c) presence of risk factors for vascular disorders and d) onset of headache under stress. Knowledge of cardiac cephalgia is scarce, due to its rare clinical occurrence and to the scant importance given to headache as a symptom concomitantly with an ischaemic cardiac event.
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Affiliation(s)
- Annamaria Bini
- Department of Neuroscience, Headache Centre, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Andrea Evangelista
- Department of Neuroscience, Headache Centre, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Paola Castellini
- Department of Neuroscience, Headache Centre, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Giorgio Lambru
- Department of Neuroscience, Headache Centre, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Tullia Ferrante
- Department of Neuroscience, Headache Centre, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Gian Camillo Manzoni
- Department of Neuroscience, Headache Centre, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Paola Torelli
- Department of Neuroscience, Headache Centre, University of Parma, Via Gramsci 14, 43100 Parma, Italy
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Abstract
Three normal children with headache occurring only with exertion were advised to try "head cooling" (eg, immersion of the head in cold water, cold water poured over the head, application of a cold, wet towel or ice pack) at the onset of headache. The patients were followed up quarterly as outpatients, and the effectiveness of head cooling in terms of the frequency of headaches, intensity (interference with play), duration, and side effects was assessed over 18 months.
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Abstract
Sport and exercise-induced migraines are difficult to distinguish from benign exertional headaches and other headache syndromes. Exertion can be the sole cause, or may be among multiple triggers for an individual's headache. Because approximately 10% of these headaches have an organic origin, a careful history and physical examination is necessary. The hallmark of treatment for exercise-induced migraines tends to be proper warm-up before exercise, minimization of environmental risks, proper sleep hygiene, and good nutrition and hydration; however, in many cases, the pharmacologic solutions that are applied to other types of headaches may also be necessary. Because there is a lack of large trial studies on the athletic headache population, more research on the topic is needed in the future to help clarify the mechanisms, classification, and treatments of these headaches.
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Affiliation(s)
- Craig Nadelson
- Atlas Orthopaedics, Westview Hospital, Indiana University Center for Sports Medicine, Zionsville, IN 46077, USA.
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Abstract
OBJECTIVE To assess predictive value of concussion signs and symptoms based on return-to-play timelines. DESIGN Physician practice study without diagnosis that includes presentation, initial and subsequent treatment, and management of concussion. SETTING National multisite primary care sports medicine provider locations. PARTICIPANTS Twenty-two providers at 18 sites; 101 athletes (91 men, 10 women in the following sports: 73 football, 8 basketball, 8 soccer, 3 wrestling, 2 lacrosse, 2 skiing, 5 others; 51 college, 44 high school, 4 professional, and 2 recreational). MAIN OUTCOME MEASUREMENTS Duration of symptoms, presence of clinical signs, and time to return to play following concussion. RESULTS One hundred one concussions were analyzed. Pearson chi2 analysis of common early and late concussion symptoms revealed statistical significance (P < 0.05) of headache >3 hours, difficulty concentrating >3 hours, any retrograde amnesia or loss of consciousness, and return to play >7 days. There appeared to be a trend in patients with posttraumatic amnesia toward poor outcome, but this was not statistically significant. CONCLUSIONS When evaluating concussion, symptoms of headache >3 hours, difficulty concentrating >3 hours, retrograde amnesia, or loss of consciousness may indicate a more severe injury or prolonged recovery; great caution should be exercised before returning these athletes to play.
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Affiliation(s)
- Chad A Asplund
- Department of Family Practice, DeWitt Army Community Hospital, Fort Belvoir, VA 22060, USA.
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Abstract
We describe 4 patients with benign exertional headache presenting to the emergency department. Consideration of this uncommon cause of headache might facilitate an accurate diagnosis of those patients with headache caused by strenuous exercise.
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Affiliation(s)
- Jason Imperato
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, MA 02215, USA
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Abstract
Exercise-related headache is one of the most common medical problems affecting the modern-day athlete. Despite the high prevalence of headache in community populations, the epidemiology of sports-related headache is unclear. In certain collision sports, up to 50% of athletes report regular headaches as a consequence of their athletic participation. The classification of the different types of sport-related headache by the International Headache Society (IHS) and in previously published articles does not adequately encompass the clinical problem faced by team physicians. Confusion exists where terms such as 'effort headache' and 'exertional headache' may be used to describe similar entities. In this review, the specific headache entities discussed include benign exertional headache, effort headache, acute post-traumatic headache and cervicogenic headache. For the sports physician, an understanding of the variety of specific headache syndromes that occur with particular sports is necessary for everyday clinical practice. This article reviews the common exercise-related headache syndromes and attempts to provide a framework for their overall management. Team physicians also need to be cognisant that many of the standard preparations used to treat headaches may be banned drugs under International Olympic Committee (IOC) rules.
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Affiliation(s)
- P McCrory
- Department of Neurology, Olympic Park Sports Medicine Centre, Box Hill Hospital,Victoria, Australia.
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